Provider Demographics
NPI:1528100377
Name:HAMBLET, JUSTIN M (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:M
Last Name:HAMBLET
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 IRONWOOD PKWY STE 222
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2647
Mailing Address - Country:US
Mailing Address - Phone:208-446-7676
Mailing Address - Fax:208-446-2390
Practice Address - Street 1:2005 IRONWOOD PKWY STE 222
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2647
Practice Address - Country:US
Practice Address - Phone:208-446-7676
Practice Address - Fax:208-446-2390
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA203004288OtherEIN
WA203004288OtherEIN
WAG8854671Medicare ID - Type UnspecifiedPERSONAL PROVIDER #
WAV05810Medicare UPIN